Approach to a fever (0-60 days) Quiz: Ace Your Exams

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A 42-day-old boy is brought to the emergency department for new-onset fever. The infant was born at 39 weeks and 2 days and is fed a combination of breast milk and formula. The pregnancy was complicated by breech presentation requiring a c-section. He was doing well until earlier that afternoon when he felt warm to touch and was difficult to soothe. Parents deny upper respiratory or gastrointestinal symptoms. There are no known sick contacts. Temperature is 38.8°C (101.8°F), pulse is 185/min, respirations are 46/min, blood pressure is 75/45 mmHg, and oxygen saturation is 98% on room air. On physical examination, the patient appears tachypneic without increased work of breathing. Which of the following findings on history or physical examination would indicate the need for further testing and treatment?

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Bulging fontanelle

Four wet diapers in the last 24 hours

Maternal history of group B streptococcus

Erythematous papules and pustules over the face and scalp

Maternal history of herpes simplex virus (HSV) treated during pregnancy with antiviral therapy